Doctors steering clear of addicts

Josh Gordon and Aisha Dow

EFFORTS to tackle the abuse of prescription painkillers such as fentanyl are being hampered by a severe shortage of doctors prepared to deal with drug addicts and a lack of treatment programs.

Drug policy agencies say the shortage has become so severe they are urging the federal government to list ''drug addiction'' as a specific item for the Medicare rebate, warning that the complexity of the problem and time needed meant doctors were increasingly steering clear of the area.

The chief executive of drug policy group Anex, John Ryan, said doctors lacked a clear monetary reward for treating drug addiction, leaving only a small number from an ageing demographic who were prepared to offer help despite booming demand.

GP David Tillett.

''They need to be properly rewarded for what are sometimes really complex patients, so they do have the financial return for the time it takes,'' Mr Ryan said.

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The comments follow revelations in The Age last month that fentanyl prescriptions have soared by more than 50 times in a decade, with a flourishing black market for the powerful painkiller being fuelled by cross-border ''doctor shopping''. The Age also revealed a massive amount of fentanyl, a painkiller up to 100 time more powerful than morphine, had been stolen from Ambulance Victoria supplies, prompting the state government to announce an audit.

Efforts to deal with the problem at a national level have become bogged in the Council of Australian Governments process, with the bickering of federal and state governments hampering release of a national pharmaceutical misuse strategy.

While demand for treatment drugs methadone and buprenorphine is growing rapidly, the latest data shows the number of doctors registered to prescribe the drug treatment medication is falling.

In Victoria the number of people being treated with methadone or buprenorphine is at its highest, although last year there were just 490 prescribers, fewer than in any year since 2006.

The Coroners Court of Victoria last month confirmed 15 deaths since last December from fentanyl overdose.

The sole public methadone program in Wodonga, which has 60 places, is stretched beyond capacity, with 61 people.

Albury's program is also full, with 83 people in the pharmacotherapy clinic and six on the waiting list.

Drug workers say some patients are ''medicating themselves'' with illicit drugs including heroin as they wait for a place.

Addiction medicine specialist Professor Kate Conigrave said such people were at risk of overdose but the potential for deaths was not taken seriously enough.

''For other conditions that threaten the lives of people in their 20s and early 30s we would be falling over ourselves to make sure that they had best available care, but because of the stigma associated with drug dependence people don't make the same effort,'' Professor Conigrave said.

The single doctor who works as the prescriber at both Albury and Wodonga's public clinics, Dr David Tillett, said the two programs had been at capacity for many years.

But, more recently, they had begun to encounter a new problem - chemists' reluctance to increase the number of methadone clients they serve. ''Several of them are saying they've got enough people and don't need any more''.

Dr Tillett said there was also a shortfall of support staff because methadone and buprenorphine programs were not properly resourced by government.

It is a frustration for a GP who says he has done more good, and saved more lives working with methadone patients than in any other role in his career.

''There are some absolutely miracle changes. We see people come and within a couple of weeks it's like the lights go on,'' Dr Tillett said.